Monday, August 25, 2014

Meet Preston Alexander!

It’s a bird. It’s a plane. It’s another birth plan flying straight out the window! Can you tell I’m trying to have a sense of humor about this?

It’s a reeeeally good thing I am not some type of crazy perfectionist Type A planner, because if I was I might be having a hard time with the fact almost nothing went according to plan when Preston decided to make an entrance a week ago today.

And this is why, although I prepared the best I could to create the birth experience I wanted ahead of time, I always prefaced my plans by saying, “I realize at any point things can change.” In so many cases, they just do, and I've always been realistic about that.

Still, I don’t think I could have possibly predicted the course of events as they actually played out. Sometimes our bodies just do what our bodies want to do. Here are some noteworthy and “shake my head” moments from our delivery...

Saturday 8/16

10:45 PM - Stood up and felt something wet. Proceeded to lose my mucus plug, then felt a HUGE POP (my water breaking like Niagara Falls), and began feeling real deal contractions all within the same hour. This after my recent OB apt showed 0% effacement and 0 cm dilation just days before.

-I remember that my OB is now on his weekend anniversary getaway. How convenient!

-Call my doula, who is already working another overnight doula job. She instructs me to sleep and she’ll try to make back-up arrangements. Sleep. Ha! Losing water by what seemed like the liter with each gush and contractions are becoming stronger.

-Hubby urges me with each contraction to just go to hospital, and I continue to justify all the reasons why I don’t want to go too soon. We arrive at hospital 6 hours after waters broke. Our doula is able to meet us there.

-Arrive 90% effaced, yet only 1 cm dilated.

-On-call OB is already insinuating Pitocin is needed at this point. Shut it lady!

-Nurse, on the other hand, is awesome and totally backing up my birth plan.

Sunday  8/17

-Continue to labor naturally ALL DAY LONG in a multitude of crunchy ways (shower, birth ball, mooing like a cow, etc).

-Dilation occurring slow as 100 year old molasses. Yet, the contractions keep on coming and hurt like a SOB. This is mostly because my water broke so long ago and there’s nothing to cushion the blow of each contraction, so I’m feeling EVERYTHING times ten.

-Even though they’re strong, they’re stuck at 3-4 minutes apart forever.

-Shift change occurs. Receive 2nd nurse. Miss my old nurse.

-Learn that baby has not engaged his head, but as he’s come down a bit, he’s decided to turn face up (this is not what you want for a natural delivery).  OB is unsuccessful turning him, but will try again once he descends a bit more.

-After 18 hours of labor, I’m told I’m still only 3 cm dilated and that I’m not even technically maintaining “active labor” at this point. OK, now you’ve got to be joking, because I guarantee this has to be active labor. Nope, technically it’s not.

-After 24 hours, OB is now insinuating a C section is going to be needed, because she can’t turn baby’s head after multiple attempts and I’m basically not progressing.  Want to punch said OB in face, but ignore her and continue working with my nurse and doula on creative ways to avoid it.

-Consider getting an epidural at the slight chance that it can give me enough rest and reprieve to allow my body to just relax enough for things to turn around. (This does actually occur in a small % of people). I’m told there are no guarantees that the epidural won’t slow my contractions, but that because they are so strong on their own, it’s slightly possible the epidural could benefit me without “slowing down labor” necessarily. It’s worth a shot at this point if it can help me relax and build strength to try pushing on my own. What have we got to lose at this point? I get the epidural.

-Holy crap, I can’t feel a thing. I get a nap. I wake up and have them stop the epidural meds so I can regain feeling and try pushing this baby down some more. Contractions have unfortunately spaced apart further now though, which is what we were hoping to avoid. I knew it was a risk of course.

-I’m STILL only 4 freaking cm dilated. Laughable.

Monday  8/18

-I’m urged to do something to help things progress and am reminded that even ACOG would recommend using synthetic oxytocin (Pitocin, etc) to augment a stalled progression at this point  (18-24 hours post water breaking).  Neither I, nor my doula could argue that point. I agree to start a small dose of Pitocin (Damnit!), but told we can back off of it if enough progress occurs with contractions.

-3rd shift change, and I get back my original awesome nurse. Have we really been here that long??

-Pitocin is indeed working to increase contractions and dilate cervix. Want to cry tears of joy when they tell me I’m dilated to 8 cm. I really think I can do this.

-Because I want the best chance to push, we do something really brave and taper off the epidural as well to catch a window where I can just push to my heart’s content and actually FEEL what I’m doing. I know I am completely bat shit crazy by the way.

-As we all see it, we are nearing our “last chance” attempts to move baby down to engage and get him to turn on his own for better positioning. Everyone in the room (nurse, doula, me, hubby) are determined. OB is taking a nap somewhere.

-Epidural officially worn off and pitocin is in agonizing full force. That drug is PURE EVIL! I push for about 2 hours straight like this.  Can’t believe I lived to tell about it.

-Trying everything to push and turn this baby. Nurse has used enough olive oil to feed an Italian army, and I am like a contortionist trying to push sideways, sitting half way up, on all fours, squatting, you name it.

-We can see baby’s head and hair while pushing, but it always goes back up during rest.

-After 30 hours of labor, my cervix is stuck at 9 cm, baby’s head is still facing wrong direction and won’t engage.

-OB voices her opinion that we should seriously consider doing a C section. I’m told that I could labor for another several hours with no further progress, even though I’m currently 9 cm, but especially considering all that we’ve already tried. My body had not established a very consistent pattern of labor on it’s own since the beginning. Highly unlikely baby will magically turn to allow shoulders under the pelvis either.

-My nurse and doula discuss the choice with us as a couple. I wish that my water hadn’t broken BEFORE having contractions, but there is nothing I can do to change that now. I cry because this is exactly what I didn’t want to happen, but I know in my heart that we’ve tried A LOT to get this baby out, and he’s JUST NOT COMING on his own.

-With either choice there are inherent risks. I realize how lucky we are that baby has not gone into distress this entire time, but there are no guarantees he won’t. I'm completely exhausted mentally, physically, and emotionally. I’m ready for the pain to be over, and we’re beyond ready to meet our baby.

-We choose to go ahead and do the C section. The minutes seem like hours as we wait for anesthesia to arrive. There is zero rest between the Pitocin induced contractions at this point, and it makes me even more content with our choice to get baby out NOW. Just do it already!

-We’re moved into the OR so fast that the anesthesia doesn’t even have time to fully work apparently, because I can actually feel them opening me up…I’m not talking about “pressure” here people. I can feel OB performing the procedure.

-Shaking like a leaf from the anesthesia being pumped into me, but moaning from the intense pain. The OB is literally yelling across the curtain at the anesthesiologist to “Get this girl something for the pain!” I can’t help but feel like I’m trapped in a bad episode of Days of Our Lives or something. lol Is this for real right now?

-Trying to get a hold of myself mentally, and the thought of meeting Preston and becoming a family with hubby gets me through. The other staff in the room try to maintain a light attitude and play “guess the baby’s weight” around the room. I guess with confidence that he’ll be 8.5 lbs.

-A few minutes later, at 6:08 AM (31 hours after my water broke), Preston Alexander finally met us face-to-face. His cry was THE MOST BEAUTIFUL THING I’ve ever heard in my life, and I began bawling like a baby myself the moment I heard it. He was given to me right away for skin-to-skin contact as they stitched me up, and we resumed following what was left in our birth plan as far as bonding time, breastfeeding, etc. He received a 9 out of 10 Apgar Score, and guess what…He weighed exactly 8 lbs. 8 oz. :)

Tuesday 8/19- Thursday 8/21

-Admitted for the mandatory 3 days post C section surgery recovery. Dad and baby all stayed in room with me the whole time.

-Half way through our stay Preston's weight dropped below normal weight loss levels (10.8%). He was deyhdrated, and completely stopped having wet and soiled diapers. He tested in the "very high" category for bilirubin (which indicated he had jaundice). He was inconsolable at times. It was heartbreaking to see him not well after being so healthy at birth. Scary couple of days for us!

-Preston received phototherapy for over 24 hours straight and was put on formula supplementation (delivered through SNS/Supplemental Nursing System). I delivered his formula through a small tube placed at the breast while I continued to breastfeed colostrum to him simultaneously. (more on this later)

Friday 8/22

-Preston gained a little weight back and began pooping/peeing again. His bilirubin returned to a healthy range.

-Discharged and finally returned home after being gone a full week. So thankful to be home!

So there you have it. "Overprepare, then go with the flow" was definitely put to use for the birth of our first born child. He was worth every prayer, every book read, every expert consulted, every battle fought, every moment we waited, and every single tear of joy and pain shed on his behalf along the way. I still can't believe that Preston is actually here and he's ours. He's absolutely perfect in every way!

Born 8/18 @ 8 lbs. 8 oz.


Broke my heart to see him so unhappy like this under phototherapy lights.
I know it could be worse, but this was really hard. I didn't sleep a wink.

Having some fun one night on a break from phototherapy.
Michael Phelps has got nothing on this kid's armspan!
Doing MUCH better the next day. All ready for his big
debut into the real world. If only he'll stop snoozin!

Can't believe we are finally a family of 3. :)

My handsome little date.

My two main squeezes together. Love these guys!

Trying out his snugapuppy swing. Two thumbs up.

Continuing to get some sun at home to clear out any remaining jaundice.

This face just makes me melt. Perfection.

All of us are settling in little by little.

Thursday, August 14, 2014

Single Digits...Maybe?

The irony... The first half of this pregnancy I was so concerned with carrying a healthy baby to full term. Perhaps it's because so many people are delivering early these days and/or experiencing NICU stays; whether it's from carrying multiples, choosing to do elective C sections, OB's pushing inductions to accommodate busy schedules, or some just delivering early naturally. For the most part, I think most pregnant women would agree, it's like you sit there holding your breath to make it past the Week 20's and into the 30's, and then when you get towards the end, you just start getting antsy. So, here I sit patiently waiting to see if my body will show ANY signs of impending labor whatsoever at almost 39 weeks (8 days until EDD of 8/22).

Of course, I want a fully baked bun, which means going until at least 40 weeks. I guess it would just be nice to see SOME sort of indication that this baby has ANY intention of making his debut in the next week or two...or three if it comes to that. At last OB check, I was still 0% effaced and 0 cm dilated. My cervix is basically like Fort Knox right now.

I know that everyone is different. Some people show thinning of the cervix and dilation steadily progressing in the weeks leading up to birth. They may experience baby dropping into position and contractions for weeks before delivering. Then for others, it just kind of happens all at once in the matter of 24-48 hours right before giving birth. I would love to have some sort of sign that things are beginning to move in the right direction, but if my lack of progress cervically is any indication, I'm still just holding out hope that I'll be one of those last minute moms whose baby comes just in the knick of time, before any interventions are necessary.

So when would it be time to intervene (meaning induce...ick)? Before my OB read my birth plan, he suggested that he'd recommend inducing if I went 10 days past my EDD. I DO NOT feel comfortable with this. Why? Because only 5% of babies are even born on their actual due date, and it is not uncommon at all to go 2 weeks early or 2 weeks late. This is just a fact well known for thousands of years. So, no you're not going to pump me full of meds when I'm still in a very normal range for something to happen on it's own.

True story: I, myself, was born 2 weeks late @ 8 lb. 13 oz. My parents were so poor that my mom received no prenatal care whatsoever, not even a doctor's visit prior to giving birth to me. In fact, they decided at 9 months along to move cross country from Maine to Texas, because my dad could find construction work in Texas easier. So, they drove all that way with my mom about to pop. She figured she'd just go to the nearest hospital if/when she went into labor. Then, when I was born (at a charity hospital with a doctor she didn't even know), her labor just came all at once, was very short, and I basically flew out of her vagina with a full head of hair at almost 9 lbs. Ha! At least that is what she told me.

Furthermore, ACOG's most recent recommendations even state that post date is considered past 42 weeks....not 40, not 41, but past 42 weeks. As you probably know, artificial induction (Pitocin, cervadil, cytotec, etc). causes much more painful contractions than would occur naturally. Once you opt to induce, there is a higher likelihood that you'll then request an epidural, which can then actually slow down labor (funny huh), which can then lead to baby "not progressing" or having fetal distress, which then increases likelihood of a C section, and ultimately higher risks for mom and baby both. Sounds fun right!?  I am by no means dogging anyone else who's gone this route, and inducing doesn't lead to the entire domino effect of interventions 100% of the time. I'd just prefer a natural alternative ideally.

At the end of the day, a live healthy baby is the most important outcome, and everyone has to make the decision best for them. However, you can see why induction is the enemy to most people who want a NUCB. There are women who are induced that do make it through with zero pain meds, but they are the exception rather than the rule. I would really just like to avoid all that jazz if humanly possible. Luckily, my OB has not mentioned the "I" word once in these late stages. In fact his words at our last apt a few days ago were, "Don't worry. It'll happen. I promise." Talk about a weight being lifted from my shoulders to just hear his confidence in allowing baby and my body to do it's thing in it's own time!

We will cross that bridge if we come to it, but for now I have no intention of letting anyone pull the induction card on us any time prior to 42 weeks. Nor will we fall prey to the "big baby card"...saying our baby will be too big or something crazy like that. Nope, not buying it!

Hopefully ya'll know me well enough to know I research the crap out of this stuff before forming an opinion. Baby is being closely monitored already with BPP's weekly. As long as there are no health issues with mom or with the baby and there is no disfunction indicated for the placenta, there are no real risks to either of us. Baby may just come a little late, and that's OK! A fellow mom relayed a quote to me that was drilled into her head in birthing class, and it stuck with me. They said to ask yourself, "Is mom OK? Is baby OK? Then, what's the problem?" I like that line of thinking!

So, in the meantime, I'm doing my normal...praying about it and just living my life. I've begun to do all the typical "come on baby voodoo" as far as drinking RRL tea, using a birth ball to bounce on/sway on, having intercourse, exercising 7 days/wk, and will begin acupuncture again next week if little one hasn't made an appearance by then. Also, doing all the stuff I won't have time to do once baby is here. I guess you could say this is my mantra right now...

My most recent reads, all good ones (lent from my doula)...

Got my hair did (added in some strawberry highlights)...

Did my own french pedicure (pretty proud of this)...

Have some food prepped for easy healthy dinners post-birth...

Preston's wardrobe is all washed and hung...

Most things are ready for the hospital bag, and car seat has been installed too. Now all we need is a baby!

Monday, August 4, 2014

BRCA Test Results & Belly Ninja Update (37 Wks + 3 Days)

Well, I finally did it. I had testing for the BRCA 1 & 2 genes done. It's been a long time coming. I did a pretty good job of ignoring the doctors' recommendations for long enough...and those of my step-mom (an oncology nurse) and those of my sister (who already had the testing done). The urging from all angles had reached it's max, and I figured I'd just stuck it up and bite the bullet.

You may have heard of this testing because of the publicity it received when Angelina Jolie recently hacked off her boobies after testing positive. If you haven't heard of it, BRCA 1 & 2 are genes that have been linked to increased risks for certain cancers, namely breast and ovarian, but also pancreatic and prostate. Read more about it here...
(Click to Enlarge)

Basically, only 5-10% of cancers are considered to be hereditary through a genetic link. While this is a small %, for those who do carry a genetic link, risk of certain cancers increases dramatically. So, for those carrying the BRCA 1 or 2 gene, the risk of developing breast cancer is up to 87% in their lifetime. Compared to an only 8% risk occurring in those with no familial risk in the general population that's a pretty big difference! You can see how risk compares in the general population with those who have familial risks and those with known genetic mutations here... Risk Factor Comparison
(Click to Enlarge)

Because the risks are greatly increased for those carrying this gene, the recommendations for treatment in women who test positive can range from increased monitoring (u/s, MRI's), to taking risk reducing medications (like tamoxifen), to having prophylactic surgery (ie. removing both breasts, having ovaries removed, complete hysterectomy). This is one big reason I'd been putting it off...because we are kind of in the middle of our mission to procreate and I wasn't ready to say buh-bye to my lady parts quite yet. Plus, the recos all just seemed so unnatural and barbaric in a way. However, the more I've read about it, the more I can see the usefulness in having this testing done for those with a family history. Ignorance is not always bliss in the long run.

You should consider BRCA testing if...
  • A personal history of breast cancer at age 50 or younger
  • A personal history of triple negative breast cancer
  • A personal or family history of male breast cancer
  • A personal or family history of bilateral breast cancer (cancer in both breasts)
  • A personal history of ovarian cancer
  • A parent, sibling, child, grandparent, grandchild, uncle, aunt, nephew, niece or first cousin diagnosed with breast cancer at age 45 or younger
  • A mother, sister, daughter, grandmother, granddaughter, aunt, niece or first cousin diagnosed with ovarian cancer
  • A family history of both breast and ovarian cancers on the same side of the family (either mother's or father's side of the family)
  • Ashkenazi Jewish heritage and a family history of breast or ovarian cancer

My mom was diagnosed with Stage IIIB ovarian cancer at age 45 and died at 52. Her aunt died from breast cancer at age 46. I am unsure of further familial history on that side, because although my mom had like ten siblings, she was adopted as a baby. Additionally, my mom did not have the BRCA testing done, which leaves a giant ?.  Since she didn't have genetic testing done, my sisters and I have no way of knowing if we carry either of the genes linked to these cancers (it's passed down). You can read more info. on the Komen website if you care to.

Another reason I decided to do it now is that we happen to have some pretty damn good insurance right now, although it's only temporarily being provided through COBRA.
Remember how my hubby got let go from his company of 9 years conveniently when I was newly preggo? Well, they at least covered our health insurance via COBRA through the birth of this baby. It was the least they could do if you ask me.  Hubby did get another job shortly after that (we thought everything was golden at that point!) but he was then let go again very soon after (Yep, complete asshats). Thankfully we never dropped our COBRA coverage. Phew!

Needless to say, there's no real source of income for us right now, but we are very blessed to have outstanding health coverage through Sept. 30th....$0 deductible, 100% maternity coverage, etc. So, I figured I better take advantage of awesome insurance while we have it! The BRACAnalysis is not cheap. It runs roughly $4000+, but as I stalk my claims online, it looks like our insurer is going to cover it 100%. Say a prayer that this pending claim turns green sometime this century please. I'm checking daily, and I think it should go through!

C'mon, turn green!

I'm really glad I had the testing done, especially because (drumroll please)...

In the clear! woo hoo!

I was found to have NO MUTATIONS for BRCA 1 & 2!!! When we got the call, I put the phone on speaker so hubby could hear the results alongside me. I cried tears of joy (which I did not expect at all) but they just bursted out.  I think in that moment, I was just thinking of everything my mom went through in her 7 years of ovarian cancer treatment. I am grateful that I won't have to make any hard decisions regarding removal of my reproductive organs now, or even after having kiddos. Realistically, this negative result does not guarantee I won't get cancer like both of my parents, but it does remove the greatly increased risks that would have been present if I did have the BRCA gene(s).

It's moments like those that help keep what's important in life in perspective. Hubby may be out of a job right now. We haven't really known how we're going to live, where we're going to live, etc. since February. Will we have to move? Will we make it out alive financially before we blow through our savings and lose our benefits? We've had to change a lot about the way we live our day-to-day. But, in the whole scheme of things, those "problems" just pale so much in comparison to the fact that we're both healthy, happy, and expecting a miracle in our lives any day now. There is nothing, and I mean NOTHING, more important than our health and the love that we share. Period!

And on an even brighter note, we got to see the belly ninja today. Even though we are seeing our OB weekly now, and they are performing BPP's (biophysical profile u/s) weekly, this may be our last official growth scan. It was one of my favorite apts. of this entire pregnancy.

During the BPP, they check for breathing, movement, responsiveness, and amniotic fluid levels. They like to see baby practice breathing at least once during the test. Babies tend to practice breathing about 30 sec. at a time during this stage. Preston was breathing steadily the entire test and did not stop once. This didn't surprise me, because I can see/feel him breathing all the time these days. I can literally watch his back going up and down through my belly. It's pretty surreal. Amniotic fluid looked excellent, and he was moving all over the entire test. He scored 8 out of 8 and passed with flying colors.

As far as growth goes, we were asked yet again "Um, has this baby been measuring big?" Yep, he's a fatty! I pressed the u/s tech on how much these u/s measurements can be off, and she was adamant that they usually guess within 1/2 lb from what she's seen (not the 2 lb. differential I hear many moms speaking of). So the head scratcher from what moms say vs. what all the medical professionals say continues. Only time will tell, but as of today he's supposedly already weighing 7 lb. 11 oz. and his head is in the 97th percentile of growth. He's in the 77th % of growth overall and is measuring 38 wks + 4 days (8 days ahead).

One thing we all agreed on is that most of the weight must be in his cute chubby cheeks. We saw him yawning a few times and opening his eyes...firsts for us. It's just amazing to see him maturing right before our eyes. I can tell he's really getting ready to meet us here in the real world. We are so in love and can't wait to meet him!

= hb @ 173 bpm (moving around A LOT!)
             = scored 8 out of 8 on biophysical profile u/s
             = head down and low on mom's bladder
             = measuring 38 wks + 4 days
             = weighs 7 lbs. 11 oz!

Mom = weight @ 158 (28 lbs. gained)
          = bp @ 118/76
          = 0% effaced, 0 cm dilated (cervix still closed tightly)